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Home My WebLink About6666-zNO. 4 TOWN OF SOUTHOLD BUII.I}ING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at ..... I{h$1~.$. D~.~,~IW~ ......... Street Map No.B.a.~..~.e.w...~.°.~{uck No ........... Lot No.. ~. .... .S..~..~..o..~....N...~.: ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... .J..V~..e...8..., 19.7.~. pursuant to which Building Permit No.~.t~... dated .......... .J..~.....1.~..., 1~.].., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ....1~..~.,.a..~....~e....f..a~...1.y...d?.l. 1..~.$ ..................................... The certificate is issued to .M.~.i..1..~....T:..~.~. ....... . .0~n..e.1-. ..................... (owner, lessee or tenant) of the aforesaid building. ~ Suffolk County Department of Health Approval .l{.e,~.t., .~.2... ,1.9.7~,...b,~..R.: .y.2..1~..... UNDERWRITERS CERTIFICATE N~l.7..~.~ ..... SP.~.., .23....~.. ................. HOUSE NUMBER ....7..~. ....... Street ....8~. p. ~. $..D.~.$~. .......................... FORM NO, $ TOWN OF SOUTHOLD Building Department Town Clerks Office Southold, N. Y. 11971 APPLICATION FOR CERTIFICATE OF OCCUPANCY Instructions A. This application must be filled in typewriter OR ink, and submitted Inspector with the following; for new buildings or new use: 1. Final survey of property with accurate location of alt buildings, in duplicate to the Building property lines, streets, and unusual natural or topographic features. 2. Final approval of Health Dept. of water supply and sewerage disposal--(S-9 form or equal). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Commercial buildings, Industrial buildings, Multiple Residences and similar buildings and installations, a certificate of Code compliance from the Architect or Engineer responsible for the building. 5. Submit Planning Board approval of completed site plan requirements where applicable. B. For existing buildings (prior to April 1957), Non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, buildings and unusual natural or topographic features. 2. Sworn statement of owner or previous owner as to use, occupancy and condition of buildings. 3. Date of any housing code or safety inspection of buildings or premises, or other pertinent in- formation required to prepare a certificate. C. Fees: 1. Certificate of occupancy $5.00 2, Certificate of occupancy on pre-existing dwelling or land use 3. Copy of certificate of occupancy $1.00 $5.00 Date Z'/.~...~.. ~.;....?....~...../..~....~.....~...... New Building ~.. ................ Old or Pre-existing Building ...~.. ...................... Vacant Land ............................ Locaton Of Pr ert .~....?.~. '~././../..~..~-~ ..~...~././/,~Z ~..~..,~..T/-/ ap y ........................................................................... .(..~-.Z~).......~..., ..................... Owner Or Owners Of Property .]../.~./..~./,,///.(/.J.......'~.......~./_ .~..~/,~.......~...~...~?....~.~.~.~ ..................... Subdivision/~,.~, ,~...,~'../..~.:..¥.....J~...~...~.~.,C~-~t No....~...... Block No ............. House No..Z~..~. Permit No..~...~...~..~..... Date Of Permit .~/../..~/~'..Z.~...Applicant ~.../.~..~...~...,(~......./..:.......?....~/..~.,.,t~.,,~..,o...,~'.. Health Dept. Approval ...~ ........................................ Labor Dept. Approval .............. .~....~.....~.. .................... Underwriters Approval ..~'../..~.~...~...~.~.........~...~.?..~.....Planning Board Approval Request For Temporary Certificate ........................................ Final Certificate Fee Submitted $ Construction on above described building and permit meets all applicable codes and regulations. Sworn to before me this Notary Public .............~County (stamp or sear) FOI~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 6666 Z Permission is hereby granted to: J.o..D~e~k~L....&/C...t~...~n~ .......... ......... i~t%~t~ok ................................................. rD .~t~ ltl ..new...one.. £~ni~.. awali~ .................................................................................... at premises located at ...1O.t..~ ...... I~"K~e~..~OOCl. S..~8.~:~O~ .................................................. .......................................... ~.~O.....~pJ..~r. ........... S~o~4 ........................................................ pursuant to application dated ............................ ,T.~r~.....8 ........... , 19~.3...., and approved by the Building Inspector. Fee $..~.(~) .......... REGRA', DRIVEW. , ; .,L.A,iS~$ "" !q '[ !~,!JCTION CESSPOC ,~ ;~SI RUCTION CELLAR C-,NSTFLbCIION OTHER THE NEW YORK BOARD OF FIRE UNDERWRITERS F/k BUREAU OF ELECTRICITY ~ 85 JOHN STREET, NEW YORK, NEW YORK 10038 "Gte ^~""~: ,'.3, :.~"/" A,,,,...t,on~'o. onf,,e ~"~'.'00 N 178476 THIS CERTIFIES THAT o~ly the electrlca~ equipment os described ~elow a~d ~t. ~Joced ~ the applicant name~ on the abo~e Qpplicatio~ number in t~e ~remises of ~l[iam ~. ~o~R n/sl(~e Sti~pE Dr~veR h~Ots/~/-~f [~a~view ~G.~o. ~ 5outhold p L.I. in the followlng loeation; [] Basement [] lst FI. [] 2nd FI. O%A~d~ Section Block Lot was examlned on A[~USt 19, l~Tq andfoundtobeincompliancewiththerequirementsofthisBoard. 3,""S 'u".Tc'°RS..,. 'T., A"".Tc' TA'. RANGES MT. K. 'tV. 1 12.: ~PECIAL REC'PT COOKING DECKS OVENS I DISH WASHERS SERVICE DISCONNECT 200 Cl~ OTHER APPARATUS: lO. OF S ~ETER ~QUIP. 1~'2W 1~3W 3~'3W 3'~'4W NO'C~C~COND' OF A'W'G'CC, COND. 3/0 R V I C EXHAUST FANS DIMMERS 1 NO. OF NEUTRALS A w. G OF NEUTRAL 1 1/O Electr!~ Furnace: 1-2h.Okw Water heater: 1-II.Skw ~otor/s: l-3/4hp 1-5 Ton A.C.Unit l,t. B. Hul an, Mattit uck, L.I. GINERAL MANAGIR COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST NOT BE ALTERED IN ANY MANNER. ~0k ,! Unauthorized alterat on or add on 1o this ~su~v is ' ' · section 7209 o~' the New York Stole Educatlone~aw.a v~o~atfa~ Copies o~ this su~ey mop not beering the lend su~eyo~s i~ seo~ or embossed seal shaU not be considered to be a valid c~. hereon, and to the assignees of the lending institution. Guarant~ or certifications are not transferable 1o additional institutions subs~uent owners. All distances to wells and cesspools are by location from house owners and field observations, since most wells and pools are not visible throe dimensions cannot be certified. SURVEY FOR WILLIAM T. fi ALYCE SWANSON AT BAYVlEW TOWN OF SOUTHOLD SUFFOLK COUNTY, N.Y. SGALE : I"; 40* JAN. 28, 1971 SE'P, T. I0,/974 REFERENCE ~ MAPOFBAYVIEW WOODS ESTATES FILED SEPT. 9, 1970- FILE NO. 55~0 9UARANTEEO TO LAND SURVEYOR RIVERHEADt N. Y. SUFFOLK COUNTY DEPARTMENT OF HEALTH Health Department - ~.- , , Reference Number ,,~-.~'- ~(' APPLICATION FOR APPROVAL TO CONSTRUCT A PRIVATE SEWAGE DISPOSAL SYSTEM AND A WATER SUPPLY 1. Address/7,F~C ~rc~Jr Vff~c~ ,~r~a/); ~ ~ 6. Section 2. Property Location ,l~/~/~ ~ - ' 7. Lot Nu~er~ _~K~yP~ ~jo~ ZE.~'r~ 8. Private Well/ Village ~'~F/'ya~ ,~,, ~ Townshl~ ~F~d L~ ,. 9. Public Water 3. Public Water Company ~ame Distance to 4. Lot size: Width/~J'/ feet Length/~ / feet 10. Sewa~sposal System:, A. ~O~9a~eptic tank: Precast ~-~ Equivalent Block (For Heelth Dept. Use) ll. B. Leaching pools: Number of pools ~ Precast /'{~Block ~pecial If private well, following blanks: A. B. C. D. E. fill in the Tank capacity* ~'--~jallons Pump G,P.M. ~' Total well depth. Depth to ground water Amount of water in well The undersigned CERTIFIES: "Construction of authorized installations will be in accordance with the Suffolk County Department of Health's current standards thereto~ This application will be valid for one year from the date of approval indtcmted below and may be renewed if a current local Building Department Permit is in effect. FOR HEALTH DEPARTMENT USE ONLY. Based on the information presented herewith, it is the opinion of the Health Department that an adequate and satisfactory Sewage Disposal System and Water Supply can be installed on this plot. APPROVAL DATE S-15 Rev. 4/1/73 BUILDING DE.?.ITMENT C:l~. , ~H~D, N.Y. /- ~ed ..... z~...Q... ~.. ~pp,,~,on ~o. ................................ ~o~ed ................. ~ ......... :.: .......... . ,~2~. ~,rm,, ~o . ~ ........ Dimppr~ed ~/c .......................................................... ................................................ APPLICATI~ FOR BUILDING PE~IT ~,. .......................... ~ ~-~C ~.Z~... a. lhi~ ~pplic~tion mu~/ b~ compl~t~l~ fill~ in b~ ~rit~r o~ in i~k ~nd ~mi~d in In~tor, ~ith ~ ~ o{ pl~% occumt~ pl~ plan ~ ~1~. F~ ~co~ing to ~h~ul~. b. Plot plon ~owlng I~tion of lot ond o~ b~ing* ~ pr~mise% r~lation~hip to odioining pr~mM~ or public str~t~ ore~% ond Oivi~ ~ d~t~iled d~ripti~ of I~ut o{pr~ mu~t be drown on th~ dioflmm ~hich c. ~ work cowr~ b~ thi~ ~lic~tion m~ n~ ~ comm*~ed before i~ o{ Budding d. H~n ~pmwl o{ ~i* ~pplic~ti~, ~ Building In~or ~ill i~ue ~ Building ~rmit to th~ opplieont Such ~h~ll ~ k~t on th~ premi*~ ~il~bl~ ~r in~ti~ Ihr~ th~ ~ork. ~. ~o buildi~ ,h~ll be ~cupi~ or u~ in ~hol~ or in Pa~ for ~ny pu~ose whot~v~r until ~ *boll h~w be~n ~mnted by th~ 8uildi~ Ink,tot. B i~,P'PLIC~ATIO~N .IS HEREB. Y MADE to the Building Department for the issuonce of o Building Permit purstmnt to the uA oing /one uroinonce ot the Town of Southold, Suffolk County, New York, ond other oppli¢oble laws, Ordinonces or Regulotions, for the construction of buildings, oclditions or oltemtions, or for rernovol or demolition, os herein described. The opplicont ogrees to comply with oil applicoble laws, ordinonces, building code, housing code, ond regulotlons, oral to edmit outhorized inspectors on premises ond in buildings for necessery inspections. · ~;~0,/ ....................... (Address of applicant) //~ ~' ~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No .............................................../~))/~'/E'/4/ ~/OOZ::)-~ Location of land on which proposed work will be done. Map No.: ........................................Lot No. Street and Number ............ .~....~....~. ...... ..~'....~.../.../~..~.....-~..../~../.../...~..T'~.. ............. ..~...~...~....'~..~..~...~... Municipality State existing use and occupancy of premises and intended use and occupancy of prpposecl construction: ~,'~9 C,~,-~ o. Exisiting use and occupancy ......................................................... ~ .................................................................. b. Intended use and occupancy ............... ../.........~..~.../~..../....L....~.. ......... ..~.....I~....L.=...~....L...(...N......~.. ...................................... 3. Nature of work (check which applicable): New Building ....... ~ .......... ~cl't on.. ................. Alteration .................. Repair .................. Removal .................. Demollticm .................... Other Work ...................................................... 4. Estimated Cost ........................................................... Fee ......... ~. ......................................................... (to be paid on filing this application) / 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cars .............. --~ ................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................. 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of Same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new cOnstruction: Front ............. .'7....(.~..~.. .......... Rear ...... .?.../...!..~. ........ Depth .~.~.....~.. ........... Height ....... /.~. ...... Number of Stories .~....~..../~.?..~.. 9. Size of lot: Front ......................... /....~....~....~. ........... ' .............................................. ?'~)~'; ~ ......... Rear ......... .J....~....7......~.....~.. ........... Depth...,.2'~.,...q ................. 10. Date of Purchase ........................................................ Nome of Former Owner .....'~.....~...~.. ....... ..Z?..!...~.: ........................ 11. Zone or use district in which premises are situated /~I'~....~.....'=. ....... ...'~....~...-~..I 12. Does proposed construct on via ate any zoning law, ordinance or regulation: ........ 13.' Will lot be regradecl ............................ Will excess fill be removed from premises: (v) Yes ......... ' (~ ) No 14. Name of Owner of premises ................................................................................ .! ........ ~none No ........:. ............. Name of Architect ~ ...~..0.~.~. -- .~. ~ .......................................................... ~aaress ................................ Phone No ....................... Name of Contractor ..~.0-~' .~..~E'..~. I~'~)$k'~ Address ................................ Ph PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and ndicate all set-back dimensions from property lines. Give street and block number or description according tO deed, and show street names and indicate whether interiOr or comer lot. ,JO ~' PI=E- ff 6 -~/~/ ................................................................................................. being duly sworn, deposes and says that he is the applicam (Name of individual signing controcf) above named. He is the ............... ..~...~...A~..-~...../~...~...-~...~......~. ......................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is' duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Swam to before, me~7__ this _lr~' k,/E' "L.~ ........... ~V/ ~ ' (Signature of applicant')' ........................... TERRI LE£ El. AK NOTARY PUBLIC, State of New York No. 52 6168295 (~ualifmd in Sulfolk Coultty Commission Expires ~Tarch 30, 19 D~,'r ~.: ¢':/~-73 Ir¸, ? / / , &~ 4 ON~. I:AMILV ~4'a. 5e,?b , AS .2660 9AM ]O 4PM FO& BACKFILLING FOUNDi I~LVI$1ON5: DMZ,: I ~10-0,$ 101 SIKh. iT ' JAM. AICA NLW /O.~IC 114~2 ' I:AMILV Il. ~. $ I DI:NC[ Z%. oo9'Y0 h IL --I '1: t R~,VISION5: A IL c ~1 I l~ E ' c T ~ DIIW6., ~ oAfS. ~lO-a4, 161 5TP,.r-~.I J.~/AAIcA NLW VO~.IC 11432 ON.I: I:AAAILV E L S D ~.NC I- ,J DAT[: I_ 5' CEDAR. I.I[I~AN "1-1. YO.P, IL · P, AYAAOND ~:. A IL C N I T [ C T ~O-O,~ ,I,fi ST?,[["T J~,MAICA NLW VOEF,. 11432 ON[ I:A/'AILV il [. S I D [NC [ '~o. 5S?b